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NPI Code Detail

MEDICARE: MADYSEN WILLDEN

MEDICARE: MADYSEN WILLDEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianUT

General Provider Information

NPI Number : 1457210437
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADYSEN WILLDEN
Provider Business Mailing Address
First Line : 16255 VENTURA BLVD STE 900
Second Line :
City : ENCINO
State : CA
Zip : 91436-2317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4934 S 900 W STE 31
Second Line :
City : OGDEN
State : UT
Zip : 84405-3777
Country : US
Telephone Number : 801-935-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2026
Last Update Date : 01/16/2026

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Directions to “ MADYSEN WILLDEN ” Practice Location

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